Provider Demographics
NPI:1891417473
Name:LARA BASKIN PHD LLC
Entity Type:Organization
Organization Name:LARA BASKIN PHD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:LARA
Authorized Official - Middle Name:E
Authorized Official - Last Name:BASKIN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:917-273-7896
Mailing Address - Street 1:521 PIERMONT AVE S UNIT 506
Mailing Address - Street 2:
Mailing Address - City:RIVER VALE
Mailing Address - State:NJ
Mailing Address - Zip Code:07675-5720
Mailing Address - Country:US
Mailing Address - Phone:917-273-7896
Mailing Address - Fax:201-735-2036
Practice Address - Street 1:645 WESTWOOD AVE STE 206
Practice Address - Street 2:
Practice Address - City:RIVER VALE
Practice Address - State:NJ
Practice Address - Zip Code:07675-5300
Practice Address - Country:US
Practice Address - Phone:201-735-2036
Practice Address - Fax:201-735-2036
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-12
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty